Epilepsia
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Randomized Controlled Trial Multicenter Study Clinical Trial
Vagus nerve stimulation for treatment of partial seizures: 2. Safety, side effects, and tolerability. First International Vagus Nerve Stimulation Study Group.
Vagus nerve stimulation (VNS) significantly reduces the frequency of partial seizures in refractory epilepsy patients. We examined the serious adverse events, side effects, and tolerability as they relate to the surgical implant procedure and the stimulating device. We also reviewed potential drug interactions, device output complications, and impact of the therapy on overall health status. ⋯ Antiepileptic drug (AED) plasma concentrations were not affected by VNS. The implant procedure, stimulating system, and therapy proved safe and tolerable during the study. The high percentage (67 of 68) of patients completing the study reflects patient acceptance and tolerability of this mode of therapy.
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Randomized Controlled Trial Multicenter Study Clinical Trial
Vagus nerve stimulation for treatment of partial seizures: 3. Long-term follow-up on first 67 patients exiting a controlled study. First International Vagus Nerve Stimulation Study Group.
Vagus nerve stimulation (VNS) has demonstrated a significant anticonvulsant effect in preclinical studies, in pilot studies in humans, and in the acute phase of a multicenter, double-blinded, randomized study. After completion of a 14-week, blinded, randomized study, with 31 receiving high (therapeutic) VNS and 36 receiving low (less or noneffective) VNS, 67 patients elected to continue in an open extension phase. During the extension phase, all 67 patients received high VNS. ⋯ The previously reported side effects of hoarseness/voice change, coughing, and paresthesia (sensation in neck and jaw) continued to occur during VNS. These side effects were well tolerated. During the follow-up period, 1 patient died of thrombotic thrombocytopenic purpura (TTP) and 5 patients discontinued treatment because of unsatisfactory efficacy.
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Historical Article
Driving and epilepsy: a historical perspective and review of current regulations.
Historically, persons with seizures or epilepsy have been prohibited from driving automobiles or motor vehicles because of concern for public safety. Seizures have a tendency to recur and pose risks of traffic accidents, property damage, and personal injury. In our modern world, however, driving an automobile is such an economic and social necessity that a conflict results between our need to protect public safety and our responsibility to provide reasonable opportunities to drive for persons handicapped by seizures and epilepsy. Currently, there is a trend toward liberalization of driving standards for persons with epilepsy, but there is still considerable controversy regarding the specific driving restrictions necessary for persons with seizures, the way in which such policies should be administered, and the role physicians should have in the process.